When a fractured clavicle is fairly broken across it is more easily treated,
but when broken obliquely it is more difficult to manage. Matters are different
in these cases from what one would have supposed; for a bone fairly broken
across can be more easily restored to its natural state, and with proper
care the upper part may be brought down by means of suitable position and
proper bandaging, and even if not properly set, the projecting part of
the bone is not very sharp. But in oblique fractures the case is similar
to that of bones which have been torn away, as formerly described; for
they do not admit of being restored to their place, and the prominence
of the bone is very sharp. For the most part, then, it should be known,
no harm results to the shoulder or to the rest of the body from fracture
of the clavicle, unless it sphacelate, and this rarely happens. A deformity,
however, may arise from fracture of the clavicle, and in these cases it
is very great at first, but by and by it becomes less. A fractured clavicle,
like all other spongy bones, gets speedily united; for all such bones form
callus in a short time. When, then, a fracture has recently taken place,
the patients attach much importance to it, as supposing the mischief greater
than it really is, and the physicians bestow great pains in order that
it may be properly bandaged; but in a little time the patients, having
no pain, nor finding any impediment to their walking or eating, become
negligent; and the physicians finding they cannot make the parts look well,
take themselves off, and are not sorry at the neglect of the patients,
and in the meantime the callus is quickly formed. The method of dressing
which is most appropriate, is similar to that used in ordinary cases, consisting
of cerate, compresses, and bandages; and it should be most especially known
in this operation, that most compresses should be placed on the projecting
bone, and that the greatest pressure should be made there. There are certain
physicians who make a show of superior skill by binding a heavy piece of
lead on the part in order to depress the projecting bone; but this mode
of treatment does not apply to the clavicle, for it is impossible to depress
the projecting part to any extent worth mentioning. There are others who,
knowing the fact that the bandages are apt to slip off, and that they do
not keep the projecting parts in their place, apply compresses and bandages
like the others, and then having girt the patient with a girdle, where
it is usually applied with most effect, they make a heap of the compresses
upon of the compresses upon the projecting bone when they apply them, and
having fastened the head of the bandage to the girdle in front, they apply
it so as to bring the turns of it into the line of the clavicle, carrying
them to the back, and then bringing them around the girdle they carry them
to the fore part and again backward. There are others who do not apply
the bandage round the girdle, but carry the rounds of it by the perineum
and anus, and along the spine, so as to compress the fracture. To an inexperienced
person these methods will appear not far from natural, but when tied, they
will be found of no service; for they do not remain firm any length of
time, even if the patient keep his bed, although in this position they
answer best; and yet even when lying in bed, should he bend his leg, or
should his trunk be bent, all the will be displaced; and, moreover, the
bandaging is inconvenient, in as much as the anus is comprehended by it,
and many turns of the bandage are crowded there in a narrow space. And
in the method with the girdle, the girdle cannot be so firmly girt around,
but that the turns of the bandage force the girdle to ascend, and hence
of necessity all the other bandages must be slackened. He would seem to
me to come nearest his purpose, although after all he effects but little,
who would take a few turns round the girdle, few turns round the girdle,
but would use the bandage principally to secure the former bandaging; for
in this manner the bandages would be most secure, and would mutually assist
one another. Every thing now almost has been said which applies to fracture
of the clavicle. But this also should be known, that in fractures of the
clavicle, it is the part attached to the breast which is uppermost, and
that the piece attached to the acromion is the lowermost. The cause of
this is, that for the most part the breast can neither be depressed nor
raised, there being but a slight movement of the joint at the breast, for
the sternum is connected together on both sides with the spine. The clavicle
admits of most motion at the joint of the shoulder, and this arises from
its connection with the acromion. And, moreover, when broken, the part
which is connected with the sternum flies upward, and is not easily forced
downward; for it is naturally light, and there is more room for it above
than below. But the shoulder, the arm, and the parts connected with them,
are easily moved from the sides and breast, and, on that account, they
admit of being considerably elevated and depressed. When, therefore, the
clavicle is broken, the fragment attached to the shoulder inclines downward,
for it inclines much more readily with the shoulder and arm downward than
upward. Matters being as I have stated, they act imprudently who think
to depress the projecting end of the bone. But it is clear that the under
part ought to be brought to the upper, for the former is the movable part,
and that which has been displaced from its natural position. It is obvious,
therefore, that there is no other way of applying force to it (for the
bandages no more force it to than they force it from); but if one will
push the arm when at the sides as much as possible upward, so that the
shoulder may appear as sharp as possible, it is clear that in this way
it will be adjusted to the fragment of the bone connected with the breast
from which it was torn. If one then will apply a bandage, secundum artem,
for the purpose of promoting a speedy cure, and will reckon everything
else of no value, except the position as described, he will form a correct
opinion of the case, and will effect a cure in the speediest and most appropriate
manner. It is of great importance, however, that the patient should lie
in a recumbent posture. Fourteen days will be sufficient if he keep quiet,
and twenty at most.